As we approach a General Election, the depth and extent of the crisis in the NHS is evident. In an unprecedented step, hospitals responsible for 75% of care across the country have rejected a proposal to cut the tariff (a standard amount for each type of treatment) by 1.9%. They have stated that they cannot manage a fifth round of cuts without either endangering patient safety or reducing the number of operations they perform. The majority of foundation trust hospitals are in financial deficit; 80% of all hospitals will be by the end of March. They will also face a transfer of £1.9bn to social care from April and further cuts of £290m in specialist care and £220m for some A&E services. There are insufficient numbers of nurses, GPs and A&E doctors. General practice as whole is almost broken with few trainee doctors wanting to become GPs; waiting times for appointments are running into days and sometimes weeks. Mental health service provision is a disaster area. Hospitals around the country are declaring major incidents because they are unable to cope with the number of people coming into their A&E departments and then requiring admission. Meanwhile the proportion of GDP being spent on health services is falling as a result of austerity. HANNAH CALLER and ROBERT CLOUGH report.

Accident and emergency

14.6 million people attended A&E in England in 2014, an increase of 446,049 compared to 2013. In early January 2015, six hospitals in England declared ‘major incidents’ because A&E demand had reached an unmanageable level: Scarborough Hospital in North Yorkshire, Ashford and St Peter’s Hospital and the Royal Surrey County Hospital in Surrey, and the Royal Stoke University Hospital in Staffordshire, while Cheltenham General and Gloucestershire Royal both declared their second major incident in three weeks. In this period, the number of patients waiting on trolleys to be admitted to a ward was at an all-time high, 16,000 at its peak. Direct harm to patients through delay in diagnosis and treatment is the consequence: it is estimated that up to 500 patients died last year in Britain in such situations.

Austerity is the source of the crisis. Savage budget cuts in adult social care services mean that they cannot afford to pay for the support that many elderly patients need on discharge. Such patients remain in hospital even if they are fit to leave, using beds which are needed for those requiring admission. Declining GP services mean that many are forced to go to A&E to get urgent care. Meanwhile walk-in centres are being closed, adding to the pressures. Between 2010 and 2014, 53 of the 258 walk-in centres across Britain were shut down. One in the Black Country, used by 50,000 people a year, will be closed later in 2015. A patient survey at one of five walk-in centres in Birmingham threatened with closure by Birmingham Cross City CCG showed that 39% of respondents would have gone to A&E had it not been there. Ludicrously, new guidance states that A&E departments will now have to tell the public if they have unsafe nursing levels with the aim being one nurse for four patients in A&E departments. What choice do critically ill patients have?

GP practices

In 2014, the College of General Practice estimated that as many as 543 surgeries in England, and potentially 600 across Britain, are at risk of closure within the next year because of a shortage of GPs. Since 2010, more than one in 20 of the 7,962 GP practices have been closed or merged. In June 2014 it was estimated that one in four attendances at A&E was because of problems getting a GP appointment. When a practice is closed, its patient list has to be distributed amongst neighbouring practices without any accompanying investment in space, staff or time. The incremental withdrawal of Minimum Practice Income Guarantee which was started in the financial year 2014-15 will reduce funding for GP practices in deprived or remote areas. 22 of the 98 surgeries under threat of closure are in the east London boroughs of Hackney, Tower Hamlets and Newham.

Private companies want profits

Over ten years ago in 2003, under the Labour government, private company Tribal Secta signed a three-year deal to run Birmingham’s Good Hope hospital. The hospital’s deficit increased from £839,000 to £3.5m and the contract was terminated early. On 8 January 2015, private company Circle announced its withdrawal from a contract to manage Hinchingbrooke Hospital, Cambridgeshire. Circle took over the running of Hinchingbrooke hospital in 2012. Hinchingbrooke had lost five chief executives in the previous five years and was under external review, carrying a £40m debt, with services and departments being moved to other hospitals. There was no possibility of making a profit given the financial problems of the local health economy, and in March 2014 the local commissioning group fined it £1m for poor performance. A damning report from the Care Quality Commission followed in late 2014, but Circle had already prepared to jump ship: its overall deficit is now £7m.

Last year, Serco pulled out of its clinical NHS contracts and the future of contracts for community services won by Virgin now looks uncertain, particularly since a percentage of all contracts must be paid to Richard Branson for use of the Virgin brand name. While private companies have won many contracts for community and mental health services since the Health and Social Care Act came into force in 2012, they will only make a profit by cutting staff and increasing their workload alongside cutting services. This is far easier to do with a service distributed across a wide geographical area than if it were a single hospital.

Funding crisis

At 7.8% of gross domestic product, Britain’s spending on health care is no more than average for OECD countries. It is lower than that in Belgium, Austria, Germany, France, Denmark, and the Netherlands. The Five Year Forward View published in October 2014 by NHS England’s chief executive, Simon Stevens, said that the NHS can deliver £22bn worth of savings to contribute to the estimated £30bn required by the health service by 2020. The level of productivity increase required is pie in the sky – two to three times what is currently being achieved. Stevens says that the NHS would then need £8bn additional money until 2020-21. However, the Health Foundation has shown that the NHS in England will need a further £65bn by 2030-31 to balance the books. With both Labour and Tory parties committed to maintain a public sector wage freeze, many staff are being forced to become agency staff to get adequately paid. The response of many hospitals is then to freeze permanent recruitment to keep within budget, exacerbating the pressure on existing permanent staff.

With their commitment to austerity, none of the major parties are prepared to do what is necessary to provide an adequate NHS: ensure it is properly funded and end all aspects of privatisation including PFI. Privatisation is not only more costly, but it fragments the NHS and reduces service levels. Organising to challenge the cuts and job losses and expose the increasing privatisation is the way to build a movement to save the NHS.